Last Friday, the D.C. Circuit rejected West Virginia’s challenge to the so-called “like it, keep it” fix, which told the states that they could temporarily decline to enforce the ACA’s new insurance rules against their insurers. (Background here.) I’m sympathetic to West Virginia’s underlying legal claim. It was unlawful, in my judgment, for the Obama […]
Last week, the Department of Justice asked the Court of Federal Claims to dismiss a massive class-action lawsuit in which co-ops have asked for money owed to them under the risk corridor program. To my knowledge, the government’s motion is its first substantive filing in any of the risk corridor cases. The litigation was precipitated […]
Dan Ho and Becky Elias have a wonderful article in the Boston Review about their new research on the benefits of peer review in restaurant inspections. Beginning in 2014, we designed a randomized, controlled trial to test the effectiveness of peer review with the food safety staff of King County, where Seattle is located. Half […]
Yesterday, the Supreme Court decided a False Claims Act suit that has enormous implications for Medicare and Medicaid fraud. The allegations in Universal Health Services v. United States ex rel. Escobar are startling. Yarushka Rivera, a young Medicaid beneficiary, died of an adverse reaction to medication that she’d received to treat her bipolar disorder. After […]
If you’re one of the six people left who still hasn’t had enough of ACA litigation, you’re in luck. Yesterday, a health plan in Maryland sued the Centers for Medicare and Medicaid Services, arguing that it has botched the implementation of the risk adjustment program. The risk adjustment program is one of the three R’s—reinsurance, […]
By my count, health plans have filed five separate lawsuits in the Court of Federal Claims seeking money that they’re owed under the risk corridor program. As I’ve explained here and here, I think the lawsuits have merit, which is why I expect to see a lot more of them. If you’re a health plan, […]
I have a new piece at the New England Journal of Medicine siding with the district court on the merits of the appropriations dispute between the House of Representatives and the Obama administration. Here’s a taste:2 The problem with the administration’s argument is that, by statute, a law “may be construed to make an appropriation […]
It was only a matter of time. Last Friday, a federal judge in Washington State entered a preliminary injunction ordering the state’s Medicaid program to pay for direct-acting antivirals—think Harvoni or Sovaldi—for any beneficiary diagnosed with Hepatitis C. Like many states, Washington has a policy of refusing to supply the drugs until the disease has […]
From Ron Klain, the former Ebola czar, in the Washington Post: If it seems like the world is being threatened by new infectious diseases with increasing frequency—H1N1 in 2009-2010, MERS in 2012, Ebola in 2014, Zika in 2016, yellow fever on the horizon for 2017—that’s because it is. These are not random lightning strikes or […]
Don’t panic about House v. Burwell. From the New York Times on what might happen if the House prevails in House v. Burwell: A study by the Department of Health and Human Services estimated that premiums for midlevel “silver plans” could rise by nearly 30 percent without [cost-sharing] reimbursements. Many consumers would be protected, since […]
Having previously held that the House of Representatives has standing to sue, the district court in House v. Burwell has now held that the Obama administration is violating the Appropriations Clause in making cost-sharing payments under the ACA in the absence of the requisite congressional appropriation. The court has stayed its decision pending appeal, meaning […]
From his perch at Politico, Dan Diamond has launched what promises to be a terrific new health-policy podcast, Pulse Check, with an interview with CMS’s acting administrator, Andy Slavitt. The interview is refreshingly candid: among other things, Slavitt confesses that the Obama administration has a lot of work to do to win back the hearts […]
I’ve already groused about the Supreme Court’s decision in Liberty Mutual v. Gobeille, which reads ERISA to preempt state laws that ask self-insured plans to share claims data with all-payer claims databases (APCDs). Not only is the decision wrong, but it will hamper price transparency and frustrate health-care research. Sensitive to the concerns, the Court […]
John Malcolm and Michael Cannon—yes, the Michael Cannon of King v. Burwell fame—have a new op-ed accusing members of Congress and/or their staffers of committing a federal crime. Documents obtained under the Freedom of Information Act show that unnamed officials who administer benefits for Congress made clearly false statements when they originally applied to have […]
In Gobeille v. Liberty Mutual , the Supreme Court held that ERISA trumps state laws that require self-insured employers to share data on the prices they paid for health care for their employees. Predictably, and sadly, those employers look like they’re taking full advantage (paywalled) of the Court’s decision: Plans that provide health insurance in […]